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Abstract Details
Variations in Textbook Oncologic Outcomes After Curative-Intent Resection: Early Versus Intermediate Hepatocellular Carcinoma Based on Barcelona Clinic Liver Cancer Criteria and Child-Pugh Classification
Ann Surg Oncol. 2023 Feb;30(2):750-759. doi: 10.1245/s10434-022-12832-2.Epub 2022 Nov 20.
1Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA.
2Department of Surgery, University of Verona, Verona, Italy.
3Department of Surgery, Ospedale San Raffaele, Milan, Italy.
4Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.
5Department of Hepatibiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France.
6Department of Surgery, Westmead Hospital, Sydney, NSW, Australia.
7Department of Surgery, Stanford University, Stanford, CA, USA.
8Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania.
9Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
10Department of Surgery, School of Medicine, The University of Sydney, Sydney, NSW, Australia.
11Yokohama City University School of Medicine, Yokohama, Japan.
12Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA. tim.pawlik@osumc.edu.
Abstract
Background: The impact of early versus intermediate hepatocellular carcinoma (HCC) on short-term "optimal" outcomes remains ill-defined. This study sought to define the incidence of textbook oncologic outcomes (TOO), as well as to identify factors associated with TOO among patients with early versus intermediate HCC.
Methods: Patients who underwent curative-intent liver resection for HCC (1998-2020) were identified from a multi-institutional database. Textbook oncologic outcome (TOO) was defined as negative surgical margins, no return to the operating room, no extended hospital stay, no severe complications, and no 90-day mortality or readmission. Patients were stratified as early HCC (BCLC 0 or BCLC A/Child-Pugh A) or intermediate HCC (BCLC A/Child-Pugh B or BCLC B). Multivariate logistic regression analysis was used to assess factors associated with TOO.
Results: Among 1383 patients, the overall incidence of TOO was 69.0%. Patients with intermediate HCC were less likely to achieve a TOO (early [71.6 %] vs. intermediate [60.1%]; p < 0.001). On multivariate analysis, factors associated with decreased odds of a TOO were high tumor burden (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.33-1.00), high aspartate transaminase-platelet ratio index (APRI) (OR, 0.46; 95% CI, 0.30-0.70), Charlson Comorbidity Index (CCI) greater than 3 (OR, 0.67; 95% CI, 0.49-0.91), major liver resection (OR, 0.68; 95% CI, 0.52-0.90), and intermediate HCC (OR, 0.68; 95% CI, 0.50-0.93) (all p < 0.05). Notably, although high APRI, CCI greater than 3, and major liver resection contributed to lower odds of a TOO in early HCC, the only factor that adversely impacted TOO in intermediate HCC was high tumor burden.
Conclusions: Patients with intermediate HCC and early HCC patients with liver dysfunction, comorbidities, or an extensive resection were less likely to achieve an "optimal" postoperative outcome.
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